stigma

RECENT POSTS

Jeff Newell, left, in November 2014, and then on Oct. 18 of this year, after finishing his first road race (Courtesy)

As soon as the chair broke under the weight of his 533 pounds, Jeff Newell knew he wouldn’t get the job.

With a background in customer service and a culinary arts degree, Newell, of Taunton, Massachusetts, had been searching fruitlessly for work for several years. Finally, a great job near his home opened up that seemed a perfect fit with his credentials. But then came the chair-breaking incident. Humiliating, yes, but even more infuriating because the interviewer, offering neither help nor an apology, simply shook her head and made a face.

“I knew what she was thinking: ‘This person is overweight and he’s going to be lazy and why should I hire him?’ ” Newell said. The situation was mortifying emotionally, but also took a physical toll. Newell broke out in a sweat, his heart racing.

The sort of weight-based discrimination that he says he experienced is not just unpleasant and stressful; it may actually lead to premature death, a recent study finds.

While earlier research has shown that weight discrimination is associated with poor health outcomes for a variety of reasons, the new study, led by researchers at Florida State University, concludes that in addition, “weight discrimination may shorten life expectancy.”

More From CommonHealth:

The new analysis found an association only, and no causal link between discrimination and life expectancy. Still, researchers in the field say the paper, published in the journal Psychological Science, adds to a growing body of literature pointing to the deep, long-term impact of weight bias and discrimination.

“I think this is one of the most important papers to come out in the research of weight stigma,” said A. Janet Tomiyama, Ph.D., assistant professor in the Psychology Department at the University of California, Los Angeles, where she studies weight stigma and directs UCLA’s Dieting, Stress, and Health Laboratory. “The finding itself is astonishing, but even more significant is that they were able to replicate the finding across two very high quality cohort studies. The crucial implication here is that the stigma alone of being heavy can be harmful to health — and we know that weight stigma is rampant in this country.”

The findings emerged after researchers analyzed data from two separate national studies: the Health and Retirement Study (HRS), with more than 13,000 participants, and the Midlife in the United States Study (MIDUS), with more than 5,000 participants. The two studies (conducted about 10 years apart) both included reports on perceived discrimination, including weight discrimination.

The new analysis found that weight discrimination was associated with an increase in mortality risk of nearly 60 percent among both HRS and MIDUS participants and also that the increased risk “was not accounted for by common physical and psychological risk factors.” In other words, the health effects of the discrimination were teased out from the health effects of the weight itself.

In an interview, Angelina Sutin, the study’s lead researcher and an assistant professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine in Tallahassee, said the big surprise was that even after statistically controlling for other factors such as body-mass index, level of disease, depression and smoking, among others, the experience of weight discrimination was linked with people dying earlier than expected.

“What was really surprising was that the association was there not just in one sample but in two, and the associations were almost identical,” Sutin said.

Weight discrimination and bias are widespread, according to an overview on the stigma of obesity, and that translates into inequities in employment, health care and education

And that stigma appears to contribute to a “vicious cycle,” according to Tomiyama, of UCLA, who writes about “a positive feedback loop wherein weight stigma begets weight gain.”

Indeed, in an earlier study, Tomiyama found that children labeled as “too fat” had an increased risk of having an obese body mass index nearly a decade later.

So why might stigma be causing such problems, and possibly contributing to premature death?

That question wasn’t addressed in the recent study, but Sutin offered some informed speculation.

“Part of it might be stress that people are carrying around with them,” she said. But sometimes it’s where the discrimination comes from that’s meaningful. For instance, she said: “Families are often the source of weight discrimination,” and that can be particularly painful, since “families are supposed to be a support.”

Also, several studies find that weight bias is rampant among medical students and other health care providers. Even eating disorder specialists are not immune to negative stereotypes about obese patients, according to a 2014 study. This attitude among health care professionals can lead to delays in care and treatment, and also misdiagnoses, experts say.

Much of the research on weight stigma and discrimination is led by Rebecca Puhl, Ph.D., deputy director of the Rudd Center for Food Policy & Obesity and a professor in the Department of Human Development & Family Studies at the University of Connecticut. She said there are several possible mechanisms at work that could contribute to premature mortality for people subject to weight discrimination.

“Other studies have found that when people are exposed to weight stigma or discrimination, that they actually experience elevated physiological stress responses (e.g., cortisol reactivity, blood pressure) which could contribute to poor health outcomes,” Puhl wrote in an email. “In addition, studies show that exposure to weight stigma can also lead to increased calorie intake, food consumption, and binge eating, which could play roles as well. The idea here is that weight stigma can induce emotional distress, which in turn becomes a trigger for turning to some of these maladaptive eating patterns as temporary coping strategies to alleviate those negative feelings.”

Sarah Bramblette, who has a master’s degree in health law, says even though she suffers from a medical condition called Lipedema that contributed to her current weight of over 400 pounds, she has been subjected to weight discrimination throughout her life. While she says some of the nasty comments hurt her feelings, it’s the bias from health professionals that has the greatest impact.

Here’s how Bramblette opened her recent TedxNSU talk at Nova Southeastern University in Fort Lauderdale:

When I first appeared on stage, what was your perception of me? Lazy, disgusting, perhaps depressed, unmotivated, unhealthy? Based on my appearance it’s usually assumed… that my weight and my condition in life are self-induced. That’s not true, but often I don’t get a second chance to make a first impression….Weight bias that I’ve experienced in health care has hurt me physically. When doctors and nurses have the perception that I’m lazy and unmotivated and noncompliant, that influences the care they provide and it has a negative impact on my health.

December 18, 2014 | 10:32 AM | Dr. Steve Scholzman

Profound misunderstanding about mental illness — its causes, its legitimacy and its treatment — permeate our culture. And the stigma that accompanies this lack of understanding hurts, a lot. Take this example — hardly original or rare.

Imagine a 15-year-old adolescent girl with fairly severe depression. She may be a classmate of your child, or the daughter of a friend. Let’s call her Sally.

Sally’s not so ill that she needs to be in the hospital, but she’s close. Her family and I — her psychiatrist — are doing our best to get her better as quickly as possible so she can get back to school. She’s been out now for about three days. Why? She literally lacks the capacity to think clearly. It’s all she can do to drag herself out of her bed and run a toothbrush across her teeth.

(Michael Summers/Flickr)

There’s a big family history of depression so Sally’s parents are both familiar with and frightened by her struggles.

“Can you call the school and ask them to give her more time on some work?” the parents ask.

“Sure,” I say, and I get in touch with the school administrator.

“Well,” I’m told by the very well-meaning administrator, “It IS a tough time of year. The other kids are getting through it somehow. I don’t see why she should get special treatment.”

“Because she has the equivalent of the flu,” I say. I like to use analogies at these crossroads.

“But the flu feels awful. Does she have a fever? Because if she does, she shouldn’t come to school…”

“No, she doesn’t have a fever,” I say. I try another analogy. “What if she had been in a car accident, God forbid?”

“Well, that’s pretty different, isn’t it?”

“How?” I ask.

“She’d be hurt,” I’m told. “This is an entirely different thing. You’ll need to get her pediatrician to call.”

I ask the pediatrician to call, and I can feel his discomfort over the phone. “I’m not very good at making this case,” he acknowledges. “It’s probably better if you just call them back.”

(I have to wonder whether he’d be so uncomfortable if I were a gastroenterologist asking him to call the school about a patient with ulcerative colitis?) Continue reading →

Below, Lisa Lambert, the executive director of the Parent/Professional Advocacy League — subtitled “The Massachusetts Family Voice For Children’s Mental Health” — eloquently describes the public silence that usually prevails among those parents in the face of widespread stigma and hostility, and the damage it does.

By Lisa Lambert
Guest contributor

Lisa Lambert of PPAL

The best way to get help for your child with mental health issues is to talk about what’s going on. But most of us don’t, especially not at first. Adam Lanza’s mother, Nancy, was reportedly quiet about his problems. She was happy to talk about gardening, the Red Sox and her hobbies. But she was quiet (publicly at least) about her son. I have been, too. We learn to be.

Even among parents who have kids with mental health problems, many cringe at the idea of exposure. Liza Long’s stunning post,” I Am Adam Lanza’s Mother”, has prompted many parents to worry that she has exposed her 13 year old son to public scrutiny and taken a terrible risk. Other parents pour out their own stories, feeling the risk is nothing compared to the pain of dealing with mental illness all alone. I have been both kinds of parents – the one who keeps quiet and the one who shares her child’s story.

When my son was in elementary school, he was sometimes violent, explosive and unpredictable. His mind, his focus and his mood would shift and nothing could interrupt the explosion. Believe me, I tried. All I could do was send his younger brother to his “safe spot” and manage things the best I could. For reasons none of us understood, his brother was often the target. I worried for years that I would get a call that the state had removed my younger son because his older brother broke his arm or hurt him grievously. I went to all the best experts who speculated that maybe he was angry because his brother was “normal.” Why then, did he attack me too? And why did he also harm himself?

No one was ever sure about the why of it and we learned to live with the mystery and uncertainty. When he was a little older, my son was able to tell me that every day he woke up feeling emotional pain and most days it was simply horrible. When he exploded or when he hurt himself, it was like bursting a balloon, he said. The pain went away for a while. As he grew older, he hurt himself more and others less. He reasoned that it was morally a better thing to do. As his mother, I was still anguished.

When this first began, I told other mothers about it. They were the parents of his friends and had known him since he was a baby. Some of them would try to make me feel better. “All brothers fight” they’d say, “Yours are just more intense.” Some would look at me with horror or, worse yet, tell me to try things that I’d done long ago and found pretty worthless. It was clear that they thought it was either my skills or persistence that needed shoring up. I learned to avoid these discussions and got pretty good at deflecting questions. I learned to be quiet. Continue reading →

About CommonHealth

Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.GET IN TOUCH

FOLLOW US

ABOUT THIS SITE

Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

If they’re so effective, why aren’t more women using IUDs and implants? A health clinic in Worcester is getting help to put better birth control front and center — particularly long-acting birth control, in hopes of cutting the high rate of unintended pregnancy.